SOTsIALISTIChESKIY WAY OF LIFE, medico-social aspects

From Big Medical Encyclopedia

SOCIALIST WAY OF LIFE, medico-social aspects — a complex of the characteristics of a way, most essential and typical for socialist society, labor, social and political, cognitive, cultural, educational, medical and other types of activity (activity) of the people who are directly influencing their health.

Being public category, the socialist way of life in a root is opposite to a way of life under capitalism. In capitalist society there is no uniform way of life: there is a way of life of workers and a way of life of ruling classes. In bourgeois society, V. I. Lenin, «at each public layer noted the „manners of life“, the habits, the tendencies» (V. I. Lenin, Full of SOBR. soch., 5th prod., t. 25, page 342). The way of life of ruling classes with the characteristic private-ownership features caused capitalist productions of an enny-ma by the relations is opposite! to a way of life of working class from it» revolutionary outlook, collectivist morals, socialist ideals. Unlike capitalist, a socialist way of life — uniform for all classes and social groups of the population. Personifying radical revolutionary changes of Sunday * all spheres of life, the socialist way of life develops and consolidated together with strengthening of unity of socialist society, formation of the Soviet people as new historical community.

Therefore, as objective reality exist a socialist and capitalist way of life — historically arisen categories essentially different from each other. Reasonings of bourgeois ideologists about some over - or an extra class way of life are so insolvent, as well as their reasonings on a uniform human «technical civilization», «industrial society», etc.

The socialist way of life is distinguished by the new lines and features typical for socialist society, such as work, democratism, humanity, a high level of social and political activity of masses, a collectivism, friendship of the people, socialist patriotism and internationalism, communistic moral substance, social optimism, free from operation and oppression, etc. One of lines of a socialist way of life — the high medical activity which is closely connected with other its lines, with the standard of living at socialism. It integrally enters the concept «socialist civilization» about which comrade Yu. V. Andropov on a June (1983) Plenum of the Central Committee of the CPSU told as about set of a number of important conditions and factors of life of socialist society: «Here and the constant growth of consciousness and culture of people, including culture of life, behavior, and what I would call culture of reasonable consumption. Here both perfect public order, and a healthy, balanced diet, here and high quality of service of the population (with what at us, as we know, still not all is successful). Here and use of free time, full from the moral and esthetic point of view. In a word, all that it is in total worthy to be called as socialist civilization» (Materials of the Plenum of the Central Committee of the CPSU, on June 14 — 15, 1983, M., Politizdat, 1983, page 13). Such determination of the standard of living enriches idea of an image and living conditions as a continuous complex.

However the statement and development of a uniform socialist way of life does not mean yet that at socialism there are no distinctions in character, way, lifestyle of various layers, groups of the population, individuals. Do not disprove existence of a socialist way of life and manifestations contradicting it in behavior of certain people, including addictions and anti-hygienic behavioural installations. The socialist way of life is inadequate to the concept «way of life at socialism», so far as the lines incompatible with ideas of a socialist way of life occur among the population. However they are not generation of a socialist social order, are not characteristic of it and are successfully overcome by the state, workers.

It is correct to define a socialist way of life and its influence on the state of health of the population and health care it is possible only on the basis of Marxist treatments. K. Marx and F. Engels already in the early works qualified a way of life as the public phenomenon inseparably linked with way of production. They specified that the way of production is not only «... reproduction of physical existence of individuals. In a bigger degree, it is a certain way of activity of these individuals, a certain type of their life activity, their certain way of life» (K. Marx, F. Engels, Soch., 2nd prod., t. 3, page 19). In Marxist literature it is emphasized that the way of life cannot be reduced to manifestations of life of people in general. The way of life is the certain type of life activity caused eventually by objective developments of society, character of socioeconomic structures with all features of activity of the person inherent to them in unity of their quantitative and qualitative parties which are reflection of the level of development of productive forces and relations of production. In other words, the way of life is defined by nek-ry specialists as set, system of the essential lines characterizing activity of the people, classes, social groups, persons in the conditions of certain public ekonomi-cheskoy formations. At the same time the qualitative party is defined by the dominating social order, the place of a class in system of the economic and political relations, and the quantitative party — the level of development of productive forces and consumption, to-ry finds expression first of all in the standard of living, and also in other indicators.

Though the way of life is in continuous unity with living conditions, it is necessary to distinguish these concepts. Living conditions are, in essence, all the oposredstvuyushchy and causing a way of life factors, it defining or to it accompanying. Among them material and non-material factors — social, political, spiritual and moral, cultural and others, the defining way of life, and also the natural factors though which are not defining a way of life but having sometimes very significant effect on it. The way of life in a type of activity, activities of people is connected with living conditions as people react to living conditions, use them, show to them a certain relation. The image and living conditions in many respects define and mediate individual and public health.

During the studying of influence of a way of life on health of the population allocate various parties of this multidimensional category, for example production, social and political activity, activity in life, welfare activity. As large sections or types it is necessary to mark out social, labor, physical, medical activity, etc. The way of life should be studied on the basis of the systems approach allowing to reveal comprehensively interference, interaction, bonds of various elements of this system including its integrative system characteristics.

In the organization, carrying out and the analysis of results of researches of health of the population and health care, including sociological (social and hygienic), epidemiological, kliniko-social, etc., differentiation of an image and living conditions is very important. Such researches are directed usually to identification of influences of living conditions, first of all social (work, life, education, culture, food, the dwelling, budgets, education, family, intra production, organizational and many other relations), to bodies of interest and the phenomena (health of individuals, groups of people, activity of medical institutions, etc.). At the same time correlations between social conditions and the studied signs — indicators of the state of health, as a rule, are established population (see) or activity of medical institutions and their personnel — sometimes without how these social conditions are used, transformed, influence activity, activity of people and through it the studied parameters of health and the organization of medical care to the population. Thus, there can be unilateral assessment of the received results. The researches proving influence of living conditions, the material income, education level and other social factors on health of the population would be much more exact and full if not only their quantitative party (square meters of living space, the size of the salary, education level, etc.) was specially considered, but also how they are used as people in relation to them and to each other behave, that is manifestations of a way of life would be analyzed. It is known that the square meter or ruble in itself cannot influence health, it is influenced by character and a way of their utilization.

The Marxist concept of a way of life and its component — a socialist way of life have a direct bearing on health of the population and its protection; at the same time paramount value gets a conclusion about immediate effect of a way of life to human health. This conclusion is development of provision on social conditionality of health of the person as it is defined not only medicobiological laws, but first of all social influences, dependent eventually by nature and character of the public relations, social conditions and factors inherent in a specific way of social production. And if the person receives health in a sense as a gift of the nature, then depends on society whether this gift is increased or is exhausted.

In a bigger degree the social beginning is shown during the approach to the concept «public health», the Crimea it is accepted to designate the cumulative health of group of people or all population measured usually sanitarno (physician) - statistical and demographic indicators (see. Health ). Dependence of health on social factors, its social conditionality means also that it is impossible to study it and to estimate out of bonds with conditions and a way of life. It is confirmed by the numerous facts. Reflection of the antagonistic class relations, social contrasts, in particular sharply different material security of different social groups in capitalist society, the going deep social differentiation of health of the population, its indicators is (mortality, incidences, the average duration of the forthcoming life, etc.) at secure and lower-income strata. So, according to inspection of mental health of the population of New York, the Area of Manhattan, prevalence of psychoses at representatives of the lowest of «a social class» to which carry the low-paid persons or the unemployed existing on grants 8 times higher, chekhm at representatives of the most secure class of society. According to «The white book» (1971), in the USA in families with the low income (the lowest «a social class») in comparison with the most secure (the highest «a social class») is 8,7 times more than persons with vision disorders, by 6,8 times — patients with arthritises and rheumatism, by 6,3 times — patients with psychological diseases, by 4,5 times — persons with cardiovascular diseases. The similar picture takes place and in other capitalist countries. Statistical service of Great Britain sharply various levels of child mortality in different «social classes» for many years are registered: in the «lowest» classes they by 2 — 3 times exceed indicators of the «highest» classes. The indicator of perinatal mortality in 1970 made 7,5%0 for the propertied population and 27,6 °/00 for poor.

Contrary to the world of the capital where social heterogeneity of health of the population develops, in the socialist countries under the influence of process of strengthening of social uniformity of society and at a socialist way of life the tendency to social uniformity of public health was created. Social and hygienic researches of the last time do not reveal some essential distinctions in indicators of health of separate classes and social groups of the population. Relatives on the value incidences, disability, child mortality, physical development in representatives of different social groups of the population are established. Moreover, rapprochement of the studied parameters at city and villagers, persons of physical and intellectual work is recorded. The observed small fluctuations of these and other indicators at the persons belonging to various layers and groups of socialist society have no character of social contrasts.

Manifestations of social heterogeneity of health of the population in the capitalist countries and social uniformity in the socialist countries already in itself prove paramount value of a way of life, its direct influence on health. They emphasize that different (socialist, capitalist) the way of life causes essential distinctions in characteristics of health of the population and its groups.

Social and hygienic researches indicate harder and harder and diverse dependence of public health on social conditions. To approach closely studying of medico-social aspects of a way of life, to reveal direct influence of a way of life on health of the population as complex, complex dynamic system and by that helped to open mekhanizkhm a social oposredovaniye of health multidimensional boundaries - and the multidisciplinary researches including clinical, psychological, sociological, social and hygienic methods, or so-called complex social and hygienic and klinikosotsialny researches. Their results served formation of scientific bases of effective measures of prevention, treatment of diseases, rehabilitation, the organization of health care. Such researches significantly promote identification of the factors which are directly influencing health.

During the performance of these works it was established that various social conditions per se do not exert a direct impact on the state of health, but features of behavior of people, the nature of use of these conditions by them (security with housing, the income, etc.), i.e. activity in connection with them and under their influence (the intra family relations, psychological climate, distribution and use of material resources, etc.) and consequently, the separate parties of a way of life directly influence indicators of health and reproduction of the population. Very visually it was shown, for example, during the studying of the reasons of abortions. It was noticed that the decision of the woman to give rise or resort to abortion depends on living conditions (level of material security, living conditions, especially abuses of the husband of alcoholic beverages, etc.), but this dependence is mediated by the relations in a family between spouses. The intense intra family relations, despite satisfactory living and material conditions, promote increase of number of abortions whereas the normal relations between spouses even under less favorable living and material conditions lead to reduction of number of abortions. The structure of families, a situation in a family, the nature of relationship of her members, especially spouses, considerably define birth rate, affect the result of pregnancy, incidence, prevalence of acute and chronic diseases and other indicators of health.

Even at such diseases, emergence to-rykh is connected with specific physical impacts, influence of psychological climate, a family factor is established. For example, in the social and hygienic research devoted to the reasons of spread of lumbosacral radiculitis along with value of anatomic defects, the postponed injuries, the considerable physical tension, cooling, etc. the big role of family factors and first of all the unhealthy, intense family relations is shown.

A day regimen, its schedule — one of the parties of a way of life. Disturbance of work, rest, a dream, food, occupations at school, etc. adversely affects the level of the general incidence, physical and intellectual development, etc. indicators of health. The statistical evidence of negative impact of such disturbances on the frequency of emergence and weight of a course of cardiovascular, rheumatic, gastrointestinal, psychological and other diseases is obtained. It is established, in particular, that disturbance of a dream, food, walks and other types of physical activity of children in the first years of life sharply affects on their health: every third child who is not observing a day regimen had unsatisfactory indicators of health. So, division of school students into five groups for health reasons showed that belonging of each of them to this or that group, the need for various measures of medical influence (prevention, treatment, etc.) depend on the developed mode of studies, rest, the nature of public work, domestic surroundings and other factors of a way of life. In particular, it was shown that group, to a cut patients with chronic diseases, with signs of professional unfitness and even disability were carried, in the majority the school students with low social activity that is who are systematically breaking the mode of study, rest, behavior form of dysfunctional families (low cultural level of parents, intense intra domestic surroundings and other adverse factors). Prevalence of individual diseases also is in big dependence on social activity, first of all from the mode of study, life, public work, the relations of the house, at school, etc.

Especially accurately observance (disturbance) of a day regimen affects on health. It is established that in families where the day regimen was observed, the state of health of the cases inspected in 59% was recognized good, in 35% — satisfactory and in 6% — unsatisfactory, and in families where the rational day regimen was not observed, these indicators were much worse and made respectively 45, 47 and 8%. Sharp distinctions in health of observable are stated: in group of the children observing a diet, a dream, walks, a hardening only 9% are ill often whereas among often ill which are not observing the corresponding mode and carried to group with low degree of social activity percent reaches 37,8.

The given examples belong preferential to posemeyny researches, but also in other complex social and hygienic researches influence of social conditions and factors of a way of life on human health, including on prevalence of such diseases clearly comes to light, to-rye traditionally are considered only from medicobiological positions. So, during the studying of features of distribution of a carcinoma of the stomach in Western Siberia it was shown that emergence and development of this disease are influenced by such adverse factors of a way of life as disturbances of food (irregular meal, systematic food with no drink, dense food for the night, an overeating, the use of the overroasted food, spices, very hot food and so forth) in a combination to an alcohol abuse and smoking, and also considerable psychological loadings. Dependence of cancer cases of a lung on regional features of the environment, an alcohol abuse and especially is established by smoking. Close data are obtained at a social and hygienic research of prevalence of malignant new growths in professional group of drivers of cars V. B. Smulevi-chem (1977). Influence of an adverse work-rest schedule, especially in connection with the changing working schedules, lack of stable diets, alternations of work and rest and other risk factors is proved to them, to-rye cause higher, than at men in general, cancer cases of a stomach, throat, lung, leukoses.

Sociologists and social hygienists convincingly showed preferential value of social and psychological behavioural factors of a way of life in an alcohol abuse, in addiction to smoking though there are no bases to deny also the known predisposition of a number of persons to these addictions. In spite of the fact that socialism liquidates class roots of so-called social diseases, including alcoholism (see), the nek-ry social and psychological factors remaining as heritage of the past and arising again owing to certain nablagopriyatny manifestations of behavior and other reasons continue to work and promote spread of alcoholism, smoking. In the general opinion of specialists, in the conditions of a socialist system to abuse of alcoholic drinks give the traditions remaining from the past, the indulgent, complacent relation to alcohol intake, defects of education in a family, school, labor collective, shortcomings of sanitary and educational work, the family conflicts, the disorders and other subjective factors characterizing the separate adverse parties of a way of life. As a rule, a push to emergence of habits to alcoholism, smoking is the example of people around. These habits passing at a row abusing in a disease, are developed because of low culture, inability and ignorance as with advantage for health and spiritual development to fill leisure. All these factors create premises for elaboration of permanent installation of the personality oriented to an alcohol abuse. This position finds confirmation in the obtained data, according to the Crimea more than a half of total number of the teenagers abusing alcohol were brought up in families where alcohol systematically upot-treblyalsya. More than 95% from them for the first time joined alcohol aged up to 15 years under the influence of an example of family members and friends, and most often for the first time alcohol was offered to them by the immediate family.

Similar factors promote also development of a habit to smoking — a nicotinism. It is revealed that emergence and fixing of a habit to smoke are promoted by smoking of persons of the immediate environment (parents, friends, teachers, etc.), the understood feeling of prestigiousness, requirement to communication and other factors is false.

Complex social and hygienic researches indicate firmness of a stereotype of behavior and other lines of a way of life. It N confirm results of a research of the budget of time of pensioners.

37 factors of a way of life of the persons which came to old-age pension and living in the large city were studied and it is established that at vast majority of pensioners the former stereotype of behavior (a vital stereotype) remained. Despite an increase of free time and favorable conditions for the organization of rest, vigorous activity, cultural leisure, only V5 a part of pensioners rationally uses free time for preservation of the health.

In addition to the labor, social activity and other parties of a way of life influencing health it in many respects depends on the medical activity developing of the attitude of people towards the health and health of other people, implementation of medical instructions and appointments, visits of treatment and prevention facilities.

The concept «medical activity» — new, entered for studying of a way of life and its influence on health of the population. This concept did not receive the exact, complete and standard definition yet. By analogy with other types of activity entering the concept «way of life», medical activity — the collective concept reflecting all most essential types and forms of activity (behavior) of people connected with protection, improvement of individual and public health. Medical activity includes the characteristic of this span and reflecting social and economic and political, scientific and technical and other conditions, forms, ways, types of activity of bodies and healthcare institutions, medical personnel on providing the population with the disease-prevention and medical service. However medical activity does not come down only to it as includes also the most typical forms of relationship of the people connected with health, its protection, a state i.e. the medical and hygienic behavior of people depending on the level of the general and medical culture, development of health services, character and scales of knowledge of the population in questions of health care and many other factors. Here also various forms and types of so-called sanitary amateur performance of the population, participation of public organizations in health care, all types, ways of hygienic education, medical self-education, etc. can be carried. The concept «medical activity» we need development, specification, creation of the corresponding concept reflecting a role of society in public health care, its groups, certain people. But already today it is possible to give a number of examples of manifestation of medical activity. So, it was established that perinatal mortality of children in many respects depends on timeliness and the frequency of visits by mothers of clinic for women. At visit of 6 times and more than a level of perinatal mortality made 8 on 1000 births, and at rare and untimely visit, especially failure from the address to early durations of gestation, it reached 20, i.e. was almost three times higher. It was confirmed also by other researches, according to the Crimea perinatal mortality is minimum when women timely, in early durations of gestation (6 — 7 weeks) address in consultation and regularly (not less than 7 times) visit her before childbirth.

Cultural level, education, awareness in medical questions significantly influence the relation to medical instructions and councils, behavior at diseases, pregnancy and holding preventive actions. It is revealed that women with more high level of education are more often in early terms address in consultation, policlinics with the preventive purpose visit more often, implement recommendations of the doctor more honestly that favorably affects a condition of their health and the result of pregnancy.

Low medical activity especially influences health of children. Inopportuneness and rare appeals to child care medical institutions lead to development of diseases, to-rye it would be possible to prevent. E.g., at a disease of pneumonia of 22% of parents treat the child, without seeing a doctor, and 12% take sick children to kindergarten or bear in a day nursery. It leads to increase in incidence and heavier disease. Leaving of the sick child without timely medical observation and treatment during the early period leads to emergence of heavy complications, transition of a disease in hron. form. It is shown that among patients with rheumatism timely, to a disease of this heavy illness, on the occasion of others acute or the exacerbation of chronic diseases did not address more than 43% of children. And among the children who did not get sick with rheumatism (group of comparison), the number of a neosconce-tivshikhsya to the doctor was much less.

Level of coverage of the population medical examination (see) and its organization — one of indicators of medical activity significantly affecting on public health. Implementation of transition to annual medical examination of all population is of particular importance in this plan, realization to-rogo in life demands increase in medical activity of all segments of the population. Lower medical activity of country people and the corresponding differences of indicators of health in this environment are explained, in particular, by rare and not so systematic visits by villagers of treatment and prevention facilities, rather their lower hygienic culture and some other the reasons. According to given P. L. Shupika and L. M. Navrotskoy (1979), owing to distinctions in security of the cities and villages with pediatricians of the address to them in the cities make 80% to number of sick children and only 30% in the village; other children from structure of country people address therapists, paramedics and other physicians. Completeness of rural areas obstetricians-gynecologists, their experience and length of service significantly influence such indicator as timeliness of observation of pregnant women (since first months).

The understanding of structure and value of a way of life, especially socialist, allows to create and apply in the socialist countries the concept of a healthy lifestyle as universal premises of the correct organization prevention (see) diseases, first of all primary prevention (see. Prevention primary ). The healthy lifestyle as the major and besides integral aspect of a socialist way of life is directed to the preservation and promotion of health of people provided in socialist society with new type of individual and collective activity, unknown to capitalist society, the concept «healthy lifestyle» is integrally alien to Krom. In the capitalist countries individuals, especially from the well-to-do, can observe a rational day regimen too, use the qualified medical care, treat zealously the health, that is lead such life, to-ry includes elements of hygienic and medical character. But it is inadequate to the concept «healthy lifestyle» as general category, possible only at socialism.

The stated idea of a healthy lifestyle is not similar to the concept «health care», a cut is most often qualified as system of public and state measures for protection and strengthening of health of the population (prevention, treatment, rehabilitation). The healthy way of life is first of all activity, activity of the personality, group of people, the societies using material and, spiritual conditions and opportunities for the benefit of health, harmonious physical and spiritual development of the person. Health care (see), become in our country the state rule (more precisely, a subsystem) the developed socialist society, is an important, but not the only factor of a healthy lifestyle, to-ry forms all its manifestations combined. From this it follows that in public health care, his hygienic education, in implementation of prevention it is necessary to consider all variety of the influences and conditions promoting strengthening of health of the person. There is not enough overcoming the known risk factors, such as smoking, irrational, unbalanced food, alcohol abuse, hypodynamia, unfavorable conditions of work, etc. though these factors are of great importance in emergence and development hron., especially not epidemic diseases; the simultaneous accounting of many manifestations of a way of life, a complex of risk factors, behavioural, etc. the reactions which are directly influencing health is necessary. Not less important along with fight against negative sides of a way of life of particular persons to find and use factors of a healthy lifestyle, positive for health, as categories public.

Formation of a healthy lifestyle — the main lever, a basis of prevention primary (see), being initial and therefore a decisive link of the general preventive direction of socialist health care. The leading role is got by primary prevention in the solution of the major problems of health care — in fight against the cardiovascular, oncological diseases, other chronic diseases, traumatism which are nowadays in economically developed countries the reason of absolute majority of cases of death. Today paramount value exogenous is convincingly proved, to hl. obr. social, factors of a way of life in an origin of these, and also psychological, exchange and other widespread diseases. Moreover, similarity of risk factors of a number of diseases, especially dangerous to public health, is proved, primary prevention can remove or weaken to-rye. It confirms a leading role of further improvement of a way of life, fight against not hygienic behavior and addictions, overcomings other adverse parties of work and life.

It is clear, that formation of a healthy lifestyle demands joint efforts of the state, public organizations, medical institutions, the population. The comprehensive state program of prevention of diseases is based on it, in a cut the central place belongs to formation of a healthy lifestyle of the Soviet people. The program provided respectively combined actions of bodies and healthcare institutions, educations, cultures, municipal services, sport, etc. Instilling of skills of hygienic behavior shall be put in system of preschool and school education of children and teenagers; it shall be continued in system of sanitary education, a cut is oriented to promotion of a healthy lifestyle, physical culture, sport. Implementation of measures of primary prevention on the basis of formation of a healthy lifestyle shall be the most important obligation of all network of treatment and prevention facilities, including services of primary health care — out-patient clinics and policlinics, service of ambulance and obstetric aid, sanitary and anti-epidemic stations, health centers of all categories, local hospitals, etc. Primary links of health care, as well as all socialist system of public health care, first of all are designed to create a healthy lifestyle. It not only a medico-professional, but also socio-political role of health care in implementation of the strategic direction of social policy of the Communist Party and socialist state in the field of health protection of the people (see. Communist Party of the Soviet Union ). Formation of a healthy lifestyle, the preventive direction of health care and especially primary prevention — the leading motive of directive documents of party and government in the field of health care of a recent period, including the Resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About additional measures for improvement of public health care» (1982).

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Yu. P. Lisitsyn.